Jiang Jianjun, Yang Jin, Jin Yongmei, Cao Jiyu, Lu Youjin
Department of Respiratory Medicine, The Second Affiliated Hospital of Anhui Medical University.
The Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, China.
Medicine (Baltimore). 2018 Oct;97(40):e12634. doi: 10.1097/MD.0000000000012634.
The concept of sepsis was redefined recently, and a new screening system termed the quick Sequential Organ Failure Assessment (qSOFA) was recommended for identifying infected patients at high risk for death. However, the predictive value of qSOFA for mortality in patients with pneumonia remains unclear. Thus, we performed a meta-analysis with the aim of determining the prognostic value of qSOFA in predicting mortality in patients with pneumonia.
Embase, Google Scholar, and PubMed (up to March 2018) were searched for related articles. We constructed a 2 × 2 contingency table according to mortality and qSOFA scores (<2 and ≥2) in patients with pneumonia. Two investigators independently extracted data and assessed study eligibility. A bivariate meta-analysis model was used to determine the prognostic value of qSOFA in predicting mortality. I index and Q-test were used to assess heterogeneity.
Six studies with 17,868 patients were included. A qSOFA score ≥2 was related to a higher risk for death in patients with pneumonia, with a pooled risk ratio (RR) was 3.35 (95% CI, 2.24-5.01) using a random-effects model (I = 89.4%). The pooled sensitivity and specificity of a qSOFA score ≥2 to predict mortality in patients with pneumonia were 0.43 (95% CI, 0.33-0.53) and 0.86 (95% CI, 0.76-0.92), respectively. The diagnostic OR was 4 (95% CI, 3-6). The area under the summary receiver operator characteristic (SROC) curve was 0.67 (95% CI, 0.63-0.71). When we calculated the community-acquired pneumonia (CAP) subgroup, the pooled sensitivity and specificity were 0.36 (95% CI, 0.26-0.48) and 0.91 (95% CI, 0.84-0.95), respectively. The area under the SROC curve was 0.70 (95% CI, 0.66-0.74).
A qSOFA score ≥2 is strongly associated with mortality in patients with pneumonia, but the poor sensitivity of qSOFA may have limitations in the early identification of mortality in patients with pneumonia.
脓毒症的概念最近重新进行了定义，推荐使用一种名为快速序贯器官衰竭评估（qSOFA）的新筛查系统来识别有死亡高风险的感染患者。然而，qSOFA对肺炎患者死亡率的预测价值仍不明确。因此，我们进行了一项荟萃分析，目的是确定qSOFA在预测肺炎患者死亡率方面的预后价值。
检索Embase、谷歌学术和PubMed（截至2018年3月）以查找相关文章。我们根据肺炎患者的死亡率和qSOFA评分（<2和≥2）构建了一个2×2列联表。两名研究者独立提取数据并评估研究的合格性。使用双变量荟萃分析模型来确定qSOFA在预测死亡率方面的预后价值。I指数和Q检验用于评估异质性。
纳入了6项研究，共17868例患者。qSOFA评分≥2与肺炎患者较高的死亡风险相关，采用随机效应模型时合并风险比（RR）为3.35（95%CI，2.24 - 5.01）（I = 89.4%）。qSOFA评分≥2预测肺炎患者死亡率的合并敏感性和特异性分别为0.43（95%CI，0.33 - 0.53）和0.86（95%CI，0.76 - 0.92）。诊断比值比为4（95%CI，3 - 6）。汇总受试者工作特征（SROC）曲线下面积为0.67（95%CI，0.63 - 0.71）。当我们计算社区获得性肺炎（CAP）亚组时，合并敏感性和特异性分别为0.36（95%CI，0.26 - 0.48）和0.91（95%CI，0.84 - 0.95）。SROC曲线下面积为0.70（95%CI，0.66 - 0.74）。
qSOFA评分≥2与肺炎患者的死亡率密切相关，但qSOFA较差的敏感性可能在肺炎患者死亡率的早期识别方面存在局限性。
